moxibustion in early chinese medicine and its relation to the … · 2019. 7. 30. · reviewarticle...

Review ArticleMoxibustion in Early Chinese Medicine and Its Relation tothe Origin of Meridians: A Study on the Unearthed Literatures

Chang Huang,1 Jiankang Liang,1 Li Han,1 Juntian Liu,2 Mengyun Yu,1 and Baixiao Zhao1

1Beijing University of Traditional Chinese Medicine, Beijing 100029, China2Beijing Huguosi Hospital of Traditional Chinese Medicine, Beijing 100029, China

Correspondence should be addressed to Baixiao Zhao; [email protected]

Received 12 October 2016; Revised 22 December 2016; Accepted 12 January 2017; Published 19 February 2017

Academic Editor: Fabio Firenzuoli

Copyright © 2017 Chang Huang et al. This is an open access article distributed under the Creative Commons Attribution License,which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Moxibustion is an integral part of Traditional Chinese Medicine (TCM). It achieved higher level of recognition and had moregeneral application in ancient times than in contemporary life. As the vital historical sources, the records of unearthed literaturesoffered precious insights to Chinese social life pattern and medical practice in Qin and Han dynasties (221 BC–220 AD). Therewas no surprise that the bamboo and silk documents excavated from Mawangdui (马王堆) tomb, Hantanpo (旱滩坡) tomb, andother relics had a large amount of texts relevant tomoxibustion.This research sortedmoxibustion recordings from seven unearthedliteratures and discovered that moxibustion had been developed into different modalities and utilized to treat many diseases at thattime. In addition, the indications, contraindications of moxibustion, and the method of postmoxibustion care were also discussed.On this basis, some hints were provided to support the hypothesis that the practice ofmoxibustion led to the discovery ofmeridians.All our preliminary results in the research have drawn attention for this old therapy and given a new source for its application inclinic and scientific research.

1. Introduction

Moxibustion is an external therapy using burning moxa stickor cone to produce a warm sensation and moxa smoke onthe acupoints [1]. It was regarded as a principal treatmentin ancient China. The studies of the earliest known form ofChinese writing, Oracle Bone Script (Jiagu Wen, 甲骨文),indicated that moxibustion might have been applied in Yindynasty (1600 BC–1046 BC) [2]. However, it is not as popularas acupuncture today, and Zhenjiu (针灸), acupuncture-moxibustion therapy, is often misconstrued as a medicalpractice that only uses needles to cope with diseases.

The meridians (Jingmai, 经脉) are core concepts forthe practice of acupuncture-moxibustion and were firstdescribed inTheYellow Emperor’s Classic of Internal Medicine(Huangdi Neijing, 黄帝内经). This theory was based uponearlier medical treatises that referred to the vessels (Mai,脉).Many scholars agree that these earlier descriptions of thevessels influenced the development of themeridians.ModernChinese researchers have worked for over 50 years on howthe ancients discovered the vessels and gradually built the

meridian theory, but without a definite conclusion [3]. Thepurpose of the current paper is to explore how the treatmentmethod employed for the vessels, moxibustion, might havecontributed to the evolution of the vessels to the meridiansand thus to the development of meridian theory.

In China, bamboo and silk were the primary writinginstruments before the widespread use of paper [4]. Sincethe beginning of the 20th century, a large number of bambooslips and silk books have been unearthed from tombs of Qin(221 BC–206 BC) and Han (202 BC–220 AD) dynasties inChina [5, 6]. They documented valuable medical materialsand partially illustrated howChinesemedicine originated [7].

The study on the bamboo slips and silk books contributedto understanding the development ofmoxibustion beforeQinand Han dynasties and offers a new source for its applicationin clinic and scientific research. Furthermore, the explorationof the relevance between moxibustion and vessels could givean additional insight into the nature or basis of themeridians.Hence, our article commences with a summary of the textualcontents that discussed moxibustion from the unearthedliteratures. There were a total of seven bamboo slips and

HindawiEvidence-Based Complementary and Alternative MedicineVolume 2017, Article ID 8242136, 9 pageshttps://doi.org/10.1155/2017/8242136

https://doi.org/10.1155/2017/8242136

2 Evidence-Based Complementary and Alternative Medicine

silk books used in this research. From these we explored thepractice of moxibustion in early China from such aspects aspostmoxibustion care, indications, and differentmodalities ofmoxibustion by studying these records. After illustrating thecircumstances of moxibustion’s application at that time, someclues were offered to reflect the influence of moxa practice onthe development of the meridians.

2. The Records of Moxibustion inthe Unearthed Literatures

There are 25 bamboo slips and silk books involved withmedicine among all unearthed literatures. Seven of themare closely related to moxibustion and they were listed in(Table 1).

Cauterization Canon of the Eleven Vessels of the Footand Forearm and Cauterization Canon of the Eleven Yin andYang Vessels excavated fromMawangdui tomb 3 (burial dated168 BC) in Changsha of Hunan province are the earliestmonographs covering not only vessels but also the applicationof moxibustion. The books presented the information ofeleven vessels, a precursor of the twelve standard meridians.The vessel’s names, trajectories, diseases generated fromdisharmony along those vessels, and therapeutic methodswere set out. The majority of diseases mentioned in themwere urological or pain-related and moxibustion was theonly therapy [8]. As compared with Cauterization Canonof the Eleven Vessels of the Foot and Forearm, CauterizationCanon of the Eleven Yin and Yang Vessels discussed morediseases of vessels and classified them into two categories:disease that occurred when vessel perturbed (Shidongbing,是动病) and disease that occurred when giving rise to vessel(Suoshengbing, 所生病) [9], so we inferred that its writtentime might be earlier. In the earlier book, CauterizationCanon of the Eleven Vessels of the Foot and Forearm, thesentence “it should be treated by moxibustion on a certainvessel” occurred at the end of introduction of each vessel.The explanation of this sentence was that the disease shouldbe treated by moxibustion on the vessels that contributed tothe onset of disease. Although the sentence was removed inCauterization Canon of the Eleven Yin and Yang Vessels, thecontent of the postmoxibustion care was added.

Model of the Vessels is the book that mainly discussed theQi (气) and vessels. Qi is usually described as the flow ofenergy around the body. The disrupted, blocked, or unbal-ancedQimovement would lead to the generation of diseases.The book put forward the principle “taking the excess to fillup the deficiency” to treat diseases by moxibustion and Bianstones.The core idea contained in this principle is the concept“Balance,” which became an important part of TCM theorylater. The book regarded that Qimoved in accordance with acertain rule and it would be beneficial when it arrived at lowerbody but harmful at the upper body. The disease would arisewhenQi ran along the vessel and gathered at the upper body,and then moxibustion should be employed to treat it. Also,as the disease got worse, the stimulating intensity should beincreased by moxibustion on another area that was above theprevious treating area. Another significant part in this bookwas the discussion of moxibustion contraindication by a case

study on treating carbuncle. The development of carbunclewas usually divided into incipient and later period. The mainsymptoms of the former onewere redness, swelling, and ache,but without pyosis.When carbuncle continued to enlarge andthe pus came into being at later period, moxibustion use wasbanned while flint and needle should be used to incise anddrain [8].

Book of the Vessels, which was excavated in Zhangjiashan(张家山), is a collection of Cauterization Canon of theEleven Vessels of the Foot and Forearm, Cauterization Canonof the Eleven Yin and Yang Vessels, and Model of the Vessels[10]. Therefore, its contents about moxibustion could be theduplication of these three books.

Recipes for Fifty-Two Ailments is the earliest manuscriptof formulaology and moxibustion prescription. It containsabout 14,700 words (maximum number of words in all silkbooks from Mawangdui tomb), 103 diseases, 283 formulas,and eight moxibustion prescriptions [11]. Some scholarsproposed that there were eleven moxibustion prescriptionsrecorded in this silk book, but soon afterwards three pre-scriptions were found to be erroneously categorized tomoxibustion for misprinting the word “炙” (Zhi, roast) as“灸” (Jiu, moxibustion) [12]. Thus Table 2 summarized eightmoxibustion prescriptions in Recipes for Fifty-Two Ailments.

Recipes for Fifty-Two Ailments recordedmoxibustion withdifferent materials such as moxa, hessian, phaeodon, andScirpoides holoschoenus in treating diverse diseases. Thesecond prescription in “venomous snake bite” took advantageof white mustard seed to stimulate skin to blister, which wasknown as the earliest natural moxibustion. Nowadays, thefamous “Sanfu moxibustion” (Sanfu Jiu, 三伏灸) which isprimarily applied to cure winter diseases in summer has beenthe inheritance of this method. Fumemoxibustion in the firstprescription of “peritus ani,” meant combusting moxa andother herbs to produce smoke and heat on the affected part.In order to apply fume moxibustion conveniently, modernChinese doctors have developed a sitting-moxibustion appa-ratus instead of traditional manual method in treating anusdiseases [13].

Recipes for Fifty-Two Ailments also recorded the charac-ters concerned with postmoxibustion care. The eighteenthprescription in chapter “scrotal hernia” proposed a cau-tion that patients should avoid the invasion of exogenouspathogenic wind after moxibustion [14]. Postmoxibustionsore appeared frequently in moxibustion therapy. Ancientsbelieved that it is necessary to treat the sore appropriatelyto prevent further deterioration, although it tightly coupledwith the therapeutic effect [15]. Thereby, the method usingChinese medicinal herbs to treat moxibustion sore was alsointroduced in the second prescription in chapter “post-traumatic leg.”

The Ultimate Principles in the Universe is a sexual guideliterature, in which the health care methods based on Taoistsexual practices were elaborated andmoxibustion was a ther-apy to treat the diseases resulting from improper intercourse.“Seven impairments and eight supplements” (Qisun Bayi,七损八益), a renowned guiding principle for sexual intercoursementioned in the book, presented seven detrimental behav-iors and eight beneficial behaviors for health [16]. People

Evidence-Based Complementary and Alternative Medicine 3

Table1:Th

emoxibustio

n-related

unearthedliteratures.

Book

involved

with

moxibustio

nEx

cavatedtim

eEx

cavatedsites

Inferentialcom

pletiondate

Material

Maincontent

CauterizationCa

nonoftheE

leven

Vesse

lsoftheF

oota

ndForearm

(Zubi

ShiyiM

aijiu

jing,足臂十一脉灸经)

1973

Maw

angdui

Han

tomb3

(Changsha,Hun

anprovince)

DuringlateQin

andearly

Han

dynasties

Silkbo

okNam

es,trajectories,anddiseases

of11

vessels

andmoxibustio

n

CauterizationCa

nonoftheE

leven

YinandYang

Vesse

ls(Yinyang

Shiyi

Maijiu

jing,阴阳十一脉灸经)

1973

Maw

angdui

Han

tomb3

(Changsha,Hun

anprovince)

DuringlateQin

andearly

Han

dynasties

Silkbo

okNam

e,trajectorie

s,anddiseases

ofvessels

ModeloftheV

essels(M

aifa,脉法)

1973

Maw

angdui

Han

tomb3

(Changsha,Hun

anprovince)

DuringlateQin

andearly

Han

dynasties

Silkbo

ok

(1)R

elationshipbetweenQiand

vessels

(2)U

singmoxibustio

nandBian

stone

totre

atdiseases

(3)P

alpatin

gthetrajectorieso

fvesselsto

diagno

sediseases

Recip

esforF

ifty-Tw

oAilm

ents

(Wushi’er

Bing

fang,五十二病方)

1973

Maw

angdui

Han

tomb3

(Changsha,Hun

anprovince)

DuringlateQin

andearly

Han

dynasties

Silkbo

okRe

cipesfor

treating52

diseases

ininternal

medicine,surgery,andpediatric

s

TheU

ltimateP

rincip

lesin

the

Universe(Tianx

iaZh

idao

Tan,天下

至道谈)

1973

Maw

angdui

Han

tomb3

(Changsha,Hun

anprovince)

Before

ordu

ringHan

dynasty

Bambo

oslips

Principles

andskillso

fhealth

care

insexu

albehavior

Book

oftheV

essels(M

aishu,脉书)

1983-1984

Zhangjiashan

Western

Han

tomb247

(Jiangling,H

ubeiprovince)

Before

ordu

ringWestern

Han

dynasty

Bambo

oslips

(1)D

iseases

indifferent

partso

fthe

human

body

andtheirsym

ptom

s(2)T

rajectorieso

fthe

vessels

andtheir

relateddiseases

Wuw

eiMedica

lSlips(Wuw

eiHandai

Yijian,武威汉代医简)

1972

HantanpoHan

tomb

(Wuw

ei,Gan

suprovince)

Before

Easte

rnHan

dynasty

Woo

denslips

andtablets

Recipesfor

treatingdiseases

ininternal

medicine,surgery,gynecology,and

androlog

y


Table2:Th

emoxibustio

nprescriptio

nsin

Recip

esforF

ifty-Tw

oAilm

ents.

Dise

ase

Seria

lnum

berin

each

chapter

Mod

ality

Material

Moxibustio

nmetho

d

Veno

mou

ssnake

bite

Num

ber2

prescriptio

nNaturalmoxibustio

nMustard

poultic

esPu

tting

mustard

poultic

eson

thep

atient’s

vertex

cranii(G

V20)

Wart

Num

ber1

prescriptio

nSear

moxibustio

nwith

moxas

tick

Scirp

oidesh

oloschoenu

sLightin

gther

opeo

fScir

poidesholoschoenus

tocauterizethe

term

inalof

wartand

then

take

itou

t

Dysuria

Num

ber6

prescriptio

nDire

ctmoxibustio

nUnk

nown

Moxibustio

non

middletoe

ofrig

htfoot

Scrotalh

ernia

Num

ber10

prescriptio

nDire

ctmoxibustio

nMug

wortleaves,tow

Burningtowwrapp

edwith

mug

wortleaveso

nvertex

cranii(G

V20)u

ntilmoxibustio

nscar

appeared

Scrotalh

ernia

Num

ber18

prescriptio

nMoxibustio

naft

ersto

neneedletherapy

Unk

nown

Moxibustio

non

thev

ulnu

safte

rstone

needle

cutting

or“Taiyin”

(太阴)a

nd“Taiyang”(太

阳)

Scrotalh

ernia

Num

ber2

3prescriptio

nDire

ctmoxibustio

nUnk

nown

Moxibustio

non

leftshank(based

onA-B

Classic

ofAc

upun

cturea

ndMoxibustio

n,the

treatmentp

ointsm

ight

beSP

8,LR

5,or

KI8)

Externalhemorrhoidor

analfistula

Num

ber1

prescriptio

nSear

moxibustio

nwith

moxas

tick

Unk

nown

Taking

moxibustio

nto

cauterizethe

term

inal

ofhemorrhoidandthen

twistingitoff

Pruritu

sani

Num

ber1

prescriptio

nFu

mem

oxibustio

nMug

wortleaves,

mushroo

mon

thew

illow

Burningmug

wortleavesa

ndmushroo

mform

thew

illow

inah

olea

ndapplying

moxibustio

nsm

oketothep

atient’sanus


would be abnormally sweaty, wheezy, and vexed if they failedto follow these guiding principles in sexual activity. Withoutimmediate treatment, these symptoms would get worse andinduce endogenous heat (Neire, 内热), pathogenic factorsthat would attack the body in TCM. At this point, Chineseherbs or moxibustion should be taken to treat this disorderby regulating Qi [8].

WuweiMedical Slips, unearthed from theHantanpo tombbuilt in early Eastern Han dynasty (25 AD–220 AD), havelisted 45 prescriptions and more than 100 herbs on the 92bamboo slips and wooden tablets, which were made by pineand poplar wood. The application rules of moxibustion arethe important contents in these slips. On the one hand, itwas stated that certain parts of the body were not suitablefor application of moxibustion at certain ages. For example,the heart was forbidden to carry out moxibustion on atage one, abdomen at age two, and back at age three [14].As demonology influenced Chinese medicine quite a lot inancient time, above-mentioned issue might originate fromdemonological therapies and could not be validated byscientific and clinical studies. Thus some of these opinionswere not appropriate for applying in treatment now [17, 18].On the other hand the treatment timing of moxibustion wasmentioned. The ancients believed it was a critical factor toenhance efficacy that moxibustion should be applied on thedifferent acupoints in accordance with different time. Sucha record is an embryonic form of “midnight-midday ebb-flow” (Ziwu Liuzhu,子午流注), which is built on the basisof biorhythm by the medical practitioners in the successivedynasties. In addition, a treatment protocol for postmoxi-bustion care was also provided in the slips. The method wasto boil smashed Aconitum carmichaelii, Capsicum annuum,and dry Angelica together with Bactrian camel milk and thenapply them to the surface of sore [14].

3. The Practice of Moxibustion in Early China

Moxibustion was one of the oldest therapies for its inventedtime might trace back to primitive society. Mastering fire-making technique provided a prerequisite for moxibustion totake its shape. In cooking a meal or getting warm by usingfire [19], people unexpectedly found that stimulating body’sspecific location could alleviate pain and suffering. Ancientssummed up the regular stimulating methods and developedthem into a new therapy. The scenario of doing moxibustiondepicted on the oracle bones demonstrated that moxibustionhad occurred inYindynasty [2].Then it prevailed and becamethe mainstay of therapy duringQin andHan dynasties. Apartfrom unearthed literatures, the hand-down literatures (theliteratures which were handed down through arrangementand transcription by generations of scholars) also indicatedthat moxibustion had been widely used in medical field andbecame a formal therapy at that time. The Records of theGrand Historian (Shi Ji, 史记), an official Chinese historybook with a great level of influence, has covered 3000 yearsof history from Yellow Emperor to Emperor Wu of Han. Itdocumented twomoxibustion recipes in the biography chap-ter of Cang gong, whose medical cases were considered theearliest medical history records. Moreover, the moxibustion

physician, as an ancient’s profession, also frequently appearedin poetry of Tang (618 AD–907 AD) and Song (960 AD–1279AD) dynasties [20].

When analyzing the reasons for the prevailing of mox-ibustion, three plausible explanations could be discovered.First, with the limited production technology, the craftsman-ship of needles was in primitive stage and a majority of themwere made of stone. The patients suffered from bloodletting,incision, and drainage by using Bian stones. By comparison,moxibustion was easy to be accepted for less suffering bypatients. Second, the flammable materials for moxibustionwith a wide range items were apt to search. The materialssuch as mugwort leaf, Scirpoides holoschoenus, and mulberryand peach tree branches could be used. Moxa floss, which isprocessed by dried leaves of Artemisia argyi (an easily culti-vated herbaceous perennial plant), is regarded more appro-priate than any other combustion materials for moxibustioncurrently [15]. Third, moxibustion displayed certain effecton some unapproved indications of acupuncture. The YellowEmperor’s Classic of Internal Medicine (Huangdi Neijing,黄帝内经) said, “a disease that may not be treated by acupuncturemay be treated by moxibustion.”

As for the indications of moxibustion, which are asso-ciated with the prevalent diseases in different eras, they arealways of concern to scholars. During the periods ofWarringStates (475 BC–221 BC), Qin dynasty and Han dynasty, warwas frequent and iron weapon appeared. Many soldiers wereinjured and died from continual warfare. Agriculture andhandicraft, yet, largely developed; the use of lacquer-warepermeated into every walk of life and people suffered frompaints allergy and rhus dermatitis. Hence, the diseases treatedby moxibustion documented in the unearthed books weremainly affiliated to surgery, including traumatism, animalbites, purulence, and urinary and anorectal diseases [21, 22].A part of the above still continues today in contemporarymedical treatment. With advanced moxibustion therapy, theindications of moxibustion have been expanded. Over 20years, experts have investigatedmoxibustion treatment of 364diseases with animal experiment and human trials [23].

Heat syndrome (Rezheng, 热证) was referred to as fullheat syndrome (Shi Rezheng, 实热证) and empty heatsyndrome (Xu Rezheng, 虚热证). The former one with thesymptoms such as red face, red eyes, a red tongue with yellowcoating, and full rapid pulse was caused by the excess of Yang(阳) in the body or invasion by an external pathogenic factor.The empty heat is caused by a deficiency of Yin (阴) ratherthan an excess of Yang and usually has the symptoms of drymouth, dry throat at night, night sweats, a peeled tongue,and a floating and rapid pulse. Whether the heat syndromepertains to the indications of moxibustion is a controversialsubject [24]. In the late EasternHandynasty,ZhangZhongjingfirst put forward the idea that “moxibustion is not appropriatefor heat syndrome” since the heat could make the fire hurtveins [25]. But scholars disagree with it based on the studiesof unearthed literatures. The records in Cauterization Canonof the Eleven Vessels of the Foot and Forearm and Recipes forFifty-Two Ailments indicated that some diseases that belongto heat syndrome should be treated by moxibustion. TheYellow Emperor’s Classic of Internal Medicine also had the


theory of “removing the stagnation of fire by heat” (Yi ReYin Re, 以热引热). Moreover, the results of many clinicalresearches supported the idea that “heat syndrome couldbe treated by moxibustion” [26, 27], and the functions suchas antipyretic, anti-inflammation, antiviral, and regulatingimmunity have been found to contribute to this therapeuticeffect of moxibustion [15, 28, 29].

In terms of different materials and operating processes,various modalities of moxibustion have been developed inearly China. By studying the earliest moxibustion mono-graphs, it could be learned that different diseases occurringat the same vessel were treated with moxibustion in the sameway. The operating method of moxibustion was relativelysimple when it was incipiently practiced. With the compilingof Recipes for Fifty-Two Ailments, moxibustion was enrichedand various modalities such as fume moxibustion, directmoxibustion, and natural moxibustion were exploited fordifferent diseases. A range of combustible materials like towor Scirpoides holoschoenus was mixed with moxa cone tomake a fire for moxibustion. Another similar method ofadding several materials to themoxa stick was developed intothunder-firemoxibustion (one of themoxibustionmodalitiesthat used moxa stick involved diverse herbs with differentproperties to serve different treatment purposes) duringMing dynasty (1368 AD–1662 AD) [30]. Although moxastick moxibustion was the most commonly utilized amongall moxibustion modalities in recent years, it had not yetoccurred in the Qin and Han dynasties. The earliest recordabout moxa stick moxibustion was in Medical Secretes of anOfficial (Waitai Miyao,外台秘要) at Tang dynasty [31].

In order to achieve better therapeutic effect, ancientChinese doctors realized the significance of postmoxibustioncare early. The postmoxibustion care was mainly from twoaspects of the treatment ofmoxibustion sore and the notice ofdaily activity after moxibustion. For one thing, most medicalpractitioners believed that the moxibustion sore issued fromcautery was closely associated with the curative effect, soancients generally preferred to use scarring-moxibustionand realized that cauterized sore after strong stimulationwas inevitable [15]. A study indicated that the thought ofGreek medicine paralleled Chinese medicine. In the middleages of French and Greek, the common treatment named“cauterization” had a similar core idea with ancient scarring-moxibustion [32, 33]. Nevertheless, it was necessary to treatmoxibustion sore for the infection of sore could be harmfulto the patients’ health. The records of Recipes for Fifty-TwoAilments and Wuwei Medical Slips were significant initiationat moxibustion sore treatment; then the later practitionersdeveloped various methods for healing the postmoxibustionsore during a long-term medical practice. Additionally, Cau-terization Canon of the Eleven Vessels of the Foot and Forearmand Recipes for Fifty-Two Ailments had put forward certainprinciples on diet, dressing, and exercise which contributedto promoting the effect of moxibustion. Although some ofthe clinical efficacy of these treatments should be furthervalidated, the viewpoint of postmoxibustion care in ancienttime still gave a lead to modern moxibustion therapy andoffered valuable nursing experience after moxibustion forpractitioners.

4. The Relationship between Moxibustion andthe Origin of Meridians

Meridian theory is an important part of Chinese medicine;its origin and nature are still shrouded in mystery. The earlydevelopment of vessels, a rudimentary model of meridians,is primarily in relation to moxibustion practice. In theCauterization Canon of the Eleven Vessels of the Foot andForearm and Cauterization Canon of the Eleven Yin andYang Vessels, eleven vessels were presented in detail, butcontemporary meridian theory that came out from YellowEmperor’s Classic of Internal Medicine has twelve meridians[34]. As the content of meridians in Yellow Emperor’s Classicof Internal Medicine was influenced by the introduction ofvessels in two silk books, the evolution of vessels tomeridianscould be interpreted by making a comparison between thesethree books (Table 3).

As the comparative study indicated, there were manydifferences between the descriptions of the vessels andmeridians. Each of the eleven vessels has their startingpoint, terminal point, and trajectories, but no acupoints. Thestarting and terminal points on the vessels are all on thedifferent area of body, while some of them on meridiansare acupoints. The vessels are isolated from each other butthe meridians are connected in a sequence with a cyclicalcirculation. The viscera (Zangfu,脏腑) theory had not beenbuilt and the connections between viscera and vessels hadalso not been illustrated at the finishing time of two silkbooks; only some clues could be found from the relationshipbetween diseases of vessels and viscera. For the treatment,at the beginning, moxibustion was applied on vessels totreat the diseases generated from disharmony of them. Later,acupuncture was discussed more in Spiritual Pivot (LingshuJing,灵枢经). In theCauterization Canon of the ElevenVesselsof the Foot and Forearm, the Chinese glyphs of the word“vessel” was in proximity to another word “温” (Wen, warm)which was an adjective meant moderate temperature [35].When treating with moxibustion, warm sensation will beapplied on the surface of the skin. If the ancients realized theexistence of vessel when doingmoxibustion, theymight namethe vessel with a character that had close relationship withmoxibustion according to the principle of creating characters[36].This could explain why the earliest Chinese character ofvessel was “ ” (Mai, vessel) and then provide a hint that therealization of vessel may be connected with the application ofmoxibustion.

The phenomenon of propagated sensation along merid-ians means that people can sense distension, numbness,itching, tingling, or warmth run from the treating sites todistal end along the trajectory of meridian after the stimu-lation of acupuncture, moxibustion, or electrical stimulator[37]. Scholars believed the line of propagated sensationcontributed to the description of trajectory of vessels byancients [38, 39]. The records of treatment in the twoearliest vessel books suggested that moxibustion could be theprincipal therapy at that time. So it might inspire someoneto conjure up that the ancients had the specific sensationpropagated along a certain route after using moxibustion.This propagated sensation is also calledmoxibustion-esthesia


Table3:Th

ecom

paris

onbetweenYellowEm

peror’s

Classic

ofInternalMedicine,C

auteriz

ationCa

nonoftheE

leven

Vesse

lsoftheF

ootand

Forearm,and

CauterizationCa

nonoftheE

leven

Yin

andYang

Vesse

ls.

Nam

eofb

ook

CauterizationCa

nonofthe

Eleven

Vesse

lsoftheF

oota

ndForearm

CauterizationCa

nonofthe

Eleven

Yinan

dYang

Vesse

lsTh

eYellow

Emperor’s

Classic

ofInternal

Medicine

Nom

enclature

Foot/handYin/Yang

meridians

Yin/Yang

meridians

orregion

alanatom

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thorax

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and it was recorded throughout the ancient literatures. TheSpiritual Pivot stated that “when warm Qi travelled along thevessels and arrived around the body, then the blocked bloodvessels will open up.”Huangdi’sMingtangMoxibustionClassic(Huangdi Mingtang Jiujing, 黄帝明堂灸经) was a treatiseon moxibustion created in Tang dynasty and the author’snamewas not recorded.The theory presented in it was “whenmoxibustion on the inaccurate acupoints, the thermal powercould not flow away to cure diseases.” Moreover, ThousandGolden Prescriptions (Qianjing Yaofang,千金要方) describedmoxibustion-esthesia as the sensation of water running downwhen moxibustion was treated on the shoulder blades.

Likewise, modern scholars perceived the presence ofmoxibustion-esthesia and proved it by clinical research. In2000, Chinese researchers enrolled a total of 829 patientsto analyze their body’s reaction after moxibustion. It wasreported that 733 patients had the propagated sensationtravelling along meridians [40]. Professor Zhou Meisheng,a distinguished moxibustion specialist who is the author ofMoxibustionCriterion (Jiusheng,灸绳), believes that inducingmoxibustion-esthesia is an important method to improvecurative effect of moxibustion. He came up with the theory ofThree Stages of Moxibustion-esthesia. The first stage is that thesensation of numbness, itching, tingling, or warmth wouldrun along the meridian at the beginning of moxibustion.Secondly, the special sensation would arrive in the affectedarea and the intensity of sensation is correlated with diseases.The special sensation appearing in the affected area thatrepresents themoxibustion is exerting the therapeutic action.Finally, special sensation may stop propagating or travel intothe next meridian [41]. Based on this theory, some scholarsdeveloped a new method of moxibustion called ThermalSensitivity Moxibustion [42, 43]. They suggested that someacupoints become sensitive when people are undergoingpathological conditions. Doctors should apply moxibustionon these acupoints to induce moxibustion-esthesia, becausemoxibustion at these heat-sensitive acupoints had a betterefficacy than conventional moxibustion.

5. Conclusion

This study of bamboo slips and silk texts from two thousandyears ago gives a preliminary description of the circumstancesof medical practice and confirmed the important historicalstatus of moxibustion during the Qin and Han dynasties.Moxibustion was used to treat various diseases and itsindications contained almost all the common diseases whenit appeared in these early texts. Throughout the records ofmoxibustion in unearthed texts we see that moxibustiondeveloped from a unitary modality to multiple modalities.Different combustion materials and steps of the operationwere chosen for different diseases, and some modalities werestill applicable for treatment inmodern life. Postmoxibustioncare was usually neglected by modern people, while theancients attached great importance to it and gave some advicenot only for the treatment of moxibustion sore but also forthe daily activity after moxibustion.This experience deservedto be further researched for its application at clinic in thefuture. We feel that there is little doubt that moxibustion

has close links with the meridians. As the preceding discus-sion has illustrated, moxibustion was developed earlier thanacupuncture and its application has a greater chance to giverise to the origin of vessels and the evolution of the vessels tomeridians.The ancients might have perceived the propagatedsensation along some trajectories after having moxibustion.After analyzing, certain laws were found in the trajectoriesand they came up with the concept of vessels.Then the elevenvessels were gradually developed into a relatively completemeridians system over a more extended period of practice.

The unearthed texts contain rare historical information,many of them have not been made public or were damagedfrom lack of proper preservation. This paper collected sevenexisting bamboo and silk texts with records of moxibustion.In addition, there may have been interpretative mistakesdue to deviation in the analyses of these unearthed textssince Chinese written characters have undergone significantchanges over time. As the new bamboo slips and silk textsare further arranged and made public by archaeologists andscholars, further research on them might provide additionalinsight into the origin ofmoxibustion and themeridians. But,as importantly, we feel this is a good chance to draw people’sattention to the innovations of this conventional therapy.

Competing Interests

All authors declare that they have no conflict of interests.

Authors’ Contributions

Chang Huang and Jiankang Liang contributed equally to thiswork.

Acknowledgments

This work was supported by the National Natural ScienceFoundation Project of China (81373730, 81574068). Theauthors wish to thank Professor Xia Zhao for the editorialassistance.

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